Healthcare Provider Details

I. General information

NPI: 1023455102
Provider Name (Legal Business Name): SOUTHEAST PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23937 US HIGHWAY 98 STE 1
FAIRHOPE AL
36532-3354
US

IV. Provider business mailing address

23937 US HIGHWAY 98 STE 1
FAIRHOPE AL
36532-3354
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-6768
  • Fax:
Mailing address:
  • Phone: 251-928-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BRENT M HARWOOD
Title or Position: OWNER
Credential:
Phone: 251-928-6768